Use of Lasers in Laryngeal Surgery

Abstract

Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this paper, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been employed in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke’s edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon’s control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted in order to realize the full potential of this surgical tool.

Microscopic Surgery with Coblation for the Treatment of Benign Laryngeal Lesions: A Case Report

“…Laser is more costly and its heat can increase scarring and damage to adjacent tissue. Other limitations of laser include potential for endotracheal explosion thus needs special tubes for anaesthesia, mucosal burns, vocal fold webs, stenosis and glottic incompetence [8] [9]. Under normal operating circumstances, using coblation technology in place of traditional electrosurgical or laser devices can significantly reduce the risk of igniting an airway fire [4]- [6].…”

The Evolution of Laser in Laryngology

“…The particular wavelength of laser energy will decide it's precision as a scalpel and the haemostatic properties. The laser energy must be intense, sharply focused, and absorbed almost entirely at the surface for precise dissection with minimal surrounding thermal injury and tissue damage [1] [3] [4].…”

“…The increased volume of ambulatory and office-based laser surgery has an important role in reducing costs and will continue to gain increased interest in financially stretched healthcare systems around the world. The considerable amount of research that continues to develop the use of laser in otolaryngology inevitably means further advancements in its clinical application [3] [4].…”

Investigation of Experimental Wound Closure Techniques in Voice Microsurgery

“…In laser surgery, a CO 2 laser is used to ablate tissue and for coagulation of the target region (Yan, Olszewski et al 2010). Together with a micro-manipulator for precise cutting, the reduced blood loss during laser surgery enables a relatively clear view of the surgical field.…”

“…This coupled with the increased cost of equipments, maintenance, additional personnel and their training (Yan, Olszewski et al 2010), has driven the continued use of traditional "cold" voice microsurgery techniques.…”